Warner K K, Visconti J A, Tschampel M M
The Ohio State University, Columbus, USA.
Ann Pharmacother. 2000 Apr;34(4):526-8. doi: 10.1345/aph.19294.
To determine the safety of using angiotensin II receptor blockers in patients who have experienced angioedema following treatment with angiotensin-converting enzyme (ACE) inhibitors.
Clinical literature identified through MEDLINE (January 1966-August 1999). Key search terms included angioneurotic edema, angiotensin-converting enzyme inhibitors, receptors-angiotensin, and losartan.
ACE inhibitor-induced angioedema occurs with an incidence of 0.1-0.5%. Alternative therapy is necessary for patients who experience this potentially life-threatening adverse effect. Since angiotensin II receptor blockers do not increase concentrations of bradykinin, the proposed mechanism of ACE inhibitor-induced angioedema, they were presumed to be safe alternatives. Recent case reports, however, document angioedema following therapy with angiotensin II receptor blockers; 32% of the reported patients experienced a prior episode of angioedema attributed to ACE inhibitor therapy.
Until the exact cause of both ACE inhibitor- and angiotensin II receptor blocker-induced angioedema is determined, angiotensin II receptor blockers should be used with extreme caution in patients with a prior history of angioedema.
确定在使用血管紧张素转换酶（ACE）抑制剂治疗后发生血管性水肿的患者中使用血管紧张素II受体阻滞剂的安全性。
通过MEDLINE（1966年1月至1999年8月）检索到的临床文献。主要检索词包括血管神经性水肿、血管紧张素转换酶抑制剂、血管紧张素受体和氯沙坦。
ACE抑制剂引起的血管性水肿发生率为0.1 - 0.5%。对于经历这种潜在危及生命的不良反应的患者，需要替代治疗。由于血管紧张素II受体阻滞剂不会增加缓激肽浓度，而缓激肽是ACE抑制剂引起血管性水肿的推测机制，因此它们被认为是安全的替代药物。然而，最近的病例报告记录了血管紧张素II受体阻滞剂治疗后发生的血管性水肿；报告的患者中有32%曾有过因ACE抑制剂治疗引起的血管性水肿发作。
在确定ACE抑制剂和血管紧张素II受体阻滞剂引起血管性水肿的确切原因之前，有血管性水肿病史的患者应极其谨慎地使用血管紧张素II受体阻滞剂。
